U.S. cuts to foreign aid under the Trump administration have destabilized basic care in scores of low-income countries globally, leading to catastrophic public health outcomes. Reports show deaths from preventable diseases and child malnutrition have risen in countries where USAID had previously operated.

At a pre-APHA 2025 workshop Saturday, “Community-based Primary Health Care in times of Volatility and Change,” foreign aid experts discussed the fallout on community-based primary health care systems around the world since the closure of USAID. 

USAID had been instrumental in improving world health, including maternal mortality, child nutrition, clean water access, and reducing cases of HIV and tuberculosis. In 2024, USAID provided $32.5 billion in health, nutrition and disaster-relief services to people in deprived countries, according to ForeignAssistance.gov. The Trump administration ended the final USAID programs in July, with some work moved to the U.S. State Department.

Former USAID worker Nazo Kureshy, who led its child survival and health grants program, told attendees that some of USAID’s work has continued thanks to private donors. A network of partnerships involving states, nonprofit aid groups and nongovernmental agencies have remained.

“USAID is no more, but the trusted relationships continue to be mobilized,” Kureshy said.

Lisa Hilmi is executive director of CORE Group, which convenes the International Community Health Network, a cohort of over 180 organizations and individual members that advances community-based health care in low-income countries. The network focuses on improving and expanding community health practices, especially for women, children and adolescents.

Over decades, the CORE Group developed a successful model for increasing coordination and collaboration in low-income countries, including work to eradicate polio. Through USAID partnerships, the group became a leader in global maternal and child health.

Ninety percent of the CORE Group’s funding came from USAID, Hilmi said, causing the organization to scramble to attain new funding.

“This is a time of profound change, prompting new partnerships and collaborations,” she said. “We’ve gone through chaos. Now we have to find order.”

The CORE Group has brought in new partners and donors, but it has been challenging, Hilmi said.

“The values have to align,” she said. “We start by saying, ‘These are our values and this is how we operate.’”

The group is also embracing new technologies, such as drone deliveries of medicines, machine learning for more efficiency, and artificial intelligence for summarizing qualitative data.

But the best technology cannot replace the human touch — of getting to know and involving community members in the work, Hilmi said. Success means their participation in promoting healthy household behaviors and facilitating local health programs.

“You always need to start with what the community wants,” she said, “and in many places health is not on top of the agenda. But communities need to be involved or it won’t go anywhere.”

Empathy and compassion “must be maintained in this politically charged, challenging time in history,” she said.

Credit: Image courtesy PAHO via Flickr Creative Commons.